Anthem BCBS (in CT)

[FreeTheSkinny66 9]

I have Anthem BCBS (in CT) through my employer as my primary, and United Healthcare through my husband's employer as secondary insurance. The surgeon's office called both and both indicated that the coverage is there. Awesome - potentially much lower out of pocket costs!

But then I contacted them both by email asking for the specific requirements to be approved, and surprisingly, received a reply from United Healthcare that bariatric (surgical or non-surgical) is NOT covered under the plan! HUH? I provided the call reference # the surgeon's office was given when they said there WAS coverage, but UHC is like, "Sorry! No coverage!" I have asked repeatedly for the plan document so I can check for myself - you can understand why I am reluctant to take what they are saying at face value - but they redirected me to my husband's company for it. WHAT? So I am going there for it, but seriously?

Anyway...my money's all on Anthem now, so to speak. I am still waiting for their reply with the specific requirements for approval, but wanting to know if anyone has gotten the requirements in writing? I have reviewed my Anthem plan through my benefits site at work and it is not listed. Strange.

This process may kill me! lol

In the event I wind up having to look at self pay - anyone in CT have a cost estimate for self-pay here (or in surrounding area - NJ/NJ/MA?) Don't want to ask my surgeon's office about that just yet - want them to try hard to get my approved! lol I don't think Mexico is really an option for me.

I am going through Ehrlich Bariatrics.

Thanks!

Edited March 25, 2016 by FreeTheSkinny66

[BCFL 0]

I have Anthem BCBS National PPO plan and going through the process now, for my requirements I have a 6months medically supervised diet and exercise plan, a letter of recommendation from your PCP, Psych evaluation, at least 1 nutritionist visit. >40 bmi or 35 with a co morbidity. I'm not sure is BCBS of CT is any different. I just called the member number on my card and they gave me all of the information.

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[turtlekaren 1]

I have Anthem BCBS, in TX, and it's the same requirements- 6 months supervised diet, psych eval, etc. There are hoops, but we will get there!

After I got through the hoops, it's the same price as everything else per my plan- deductible then 80/20 to my out of pocket maximum.

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[silverthreads 183]

@@FreeTheSkinny66 you need to look at UHC's Evidence of Coverage document. You should be able to download it online--most likely through the benefits website from your husband's employer. Every employer has slightly different benefits so you have to get theirs. The UHC call center is notorious for giving out inaccurate info so don't rely on that.

That being said you also need to look at their coordination of benefits policy. Oftentimes the secondary won't pay much if the primary insurance has already paid as much as they would.

I know it's infuriating but that's the game... Good luck and don't give up!

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[FreeTheSkinny66 9]

@@silverthreads I was able to get the Plan Document directly from my husband's employer, and it showed that there IS coverage for WLS (the exclusion is for NON-surgical weight loss), yet UHC maintains that there is no coverage. So I asked them the effective date of the plan they were referencing, and it is different that what the company gave me. So I went back and asked for the most current version from my husband's employer, which they assured me they gave me. So.....SOMEONE is providing or looking at the wrong thing!

Since UHC refuses to send me what they are reading from, and my husband's Benefits Coordinator confirmed that I was given the most current version, I think there is coverage, but there is no way to convince UHC of that! UGH. Such a pain in the butt.

I have yet to look at coordination of benefits since I am not sure if I have the "right"document. Sigh.....